102 Chapter 4 4 psychological preparation). Hence, by involving multiple stakeholders, we were able to develop an intervention focusing on optimizing the experience for children and caregivers while working with available resources and requiring minimal efforts from healthcare professionals. Patient-centered outcomes This study demonstrated how a PD service design approach can help to develop interventions to improve paediatric patient experience by taking the experiences of the child, caregiver and healthcare provider as a starting point. Using this approach, we were able to identify critical moments in a child’s journey that add to the build-up of stress and anxiety, find ways how to alleviate these moment and benefit the overall patient experience. Increasingly, medical academics acknowledge that overall patient experience is important in creating more beneficial patient-centred outcomes, such as satisfaction of care, self-efficacy and trust in healthcare, and clinical outcomes, such as recovery time (28). As such, patient experiences are increasingly adopted in paediatric and adult care as important indicators for the quality of healthcare. The Hospital Hero app improves the overall experience by taking the patient’s experience journey as a starting point and by intervening in the potentially anxiety-heightening moments. These moments do not only involve interactions between child and healthcare professionals, but also entering the hospital building and waiting in the weighing room. Both are equally critical for the overall experience. Effective mechanisms in the Hospital Hero app Evaluation of the Hospital Hero in practice helped us to gain in-depth insight in the user experiences and interactions and identify effective mechanisms. The pilot study showed that children specifically enjoyed searching for animals, and this took their attention away from waiting or negative emotions and feelings (in the case of children who experience pre-procedural stress and anxiety). With the animal search, children are given a task (searching for and collecting animals) that they actively engage in. These more active ways of distraction are powerful as they actively divert the focus from negative emotions and the (anticipated) procedure (29). These findings correspond with studies evaluating the use of VR in which children are actively distracted by playing games (30). Moreover, the animal search requires problemsolving skills which help to empower children and give them a feeling of autonomy (I can do it myself) if performed successfully (31). By regularly changing the animals and hiding places, children can endeavour on the search each time they visit the hospital. Based on previous research, the connection of the game world with the physical world (i.e. physical QR codes as game tokens) promises to be especially powerful in transferring the child’s acquired coping skills to the real-world and is absent in preparations platforms such as ‘Xploro’ (14, 32). The feeling of autonomy and control is strengthened by the fact that the app is child-centred and directed towards the child (i.e. speaking to the child instead of about the child) without requiring active involvement from a caregiver. However, parental involvement and more specifically, their level of stress and anxiety is pivotal
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